Healthcare Provider Details

I. General information

NPI: 1831470525
Provider Name (Legal Business Name): YASMIN HORTON SAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 PRAIRE AVE SUITE 10
BELOIT WI
53511-2940
US

IV. Provider business mailing address

2422 N GRANDVIEW BLVD
WAUKESHA WI
53188-6105
US

V. Phone/Fax

Practice location:
  • Phone: 262-549-6600
  • Fax: 262-549-6698
Mailing address:
  • Phone: 262-549-6600
  • Fax: 262-549-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number155831630
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15799131
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: